Radiological evaluation of cementing quality in femoral stem arthroplasty, by free hand versus gun technique

Abstract

Background: The objective of the study was evaluate radiologically the cementing quality of femoral stem in replacement of hip by free hand versus gun technique of cementing, using grading system of Barrack’s and to find out intra observer agreement and inter observer agreement of grades for femoral stem cementation in hip replacement.Methods: In the present experimental randomized study, 50 cases of hip arthroplasty were evaluated for cementing quality of femoral stem by free hand versus gun technique of cementing. Standard anterio-posterior radiographs of hip with thigh was taken in 15 degree internal rotation and lateral view was taken in shoot through lateral projections. The radiographic evaluation of same radiographs was done at post op day one and after 6 weeks. All the subjects included in the study were subjected to comparison of cementing quality of femoral stem by using Barrack’s cement grading system. The statistical analysis was done by using SPSS version 24.0; SPSS Inc. Chicago, Illinois, USA. Interpretation and analysis of obtained results was carried out by descriptive method and data presented as summary statistics. The Kappa coefficient was calculated by statistical analysis, which assessed the agreement among tests with categorical variables.Results: The most frequent gradings were grade A in the hip replacements done by Gun technique and grade B in the cases done by Hand technique. We verified the Kappa coefficient for intra observer agreement (0.40 to 0.52), which represented modest to moderate strength of agreement and Kappa coefficient for inter observer agreement (0.45 to 0.55) which reported modest to moderate strength of agreement. Conclusion: We conclude that the Gun technique of cementing is superior to the hand cementing technique. Simple radiographic evaluation is not suitable for the assessment of cementation quality, which support previous studies recommendation not to use radiographic grading systems alone as a marker for defining the longevity of the arthroplasty.